"I won't be myself," is a valid concern about medications.I don’t like taking medication. You would never know it by looking at my medicine cabinet. While I’m thankfully not at the point where I’m taking medications for side effects, I could rival any octogenarian. Despite not liking medication, I still take it as prescribed every day. Why? Because how I feel without it is worse than how I feel when taking it. Not everyone reacts this way, though. It’s understandable. When you take medication for a mood disorder, it affects your mind. That’s kind of the point. One side effect that worries most people is that they won’t feel like themselves anymore. Even though they won’t feel depressed or manic, they worry they won’t be able to feel anything at all. It’s a legitimate concern and doctors need to respect it. There are several classes of drugs used to treat bipolar disorder, and they all come with benefits and detriments.

Antidepressants
Antidepressants are the second most commonly prescribed medication in the U.S., and are known for blunted emotions being one of their side effects. There’s actually a bigger problem when it comes to treating bipolar disorder with SSRIs. Basically, it’s a bad idea to prescribe them for bipolar disorder in the first place, even though patients spend about 50% of their time in depressive states. It turns out that antidepressents can actually induce mania in bipolar patients.

So if you don’t take antidepressants for bipolar disorder, can you avoid feeling like your emotions are dulled? Sorry, no.

Sadly, most of the medications available for bipolar disorder, even across categories, carry a risk of making you feel like a zombie.

Lithium
Lithium was the first drug used specifically to treat bipolar disorder and is still widely used. It carries a considerably lower likelihood of dulled emotions, but the risk is still there. There are also plenty of other side effects associated with lithium and only about a third of patients continue the drug long-term. However, side effects can typically be controlled with dosage. (Keep in mind that lithium blood levels are affected by many factors including menstrual cycles and time of year.)

Anticonvulsants
Anticonvulsants are also low on the list of bipolar disorder drugs that cause dulled emotions. There is a risk of other side effects including cognitive deficits: brain fog, memory problems, learning problems, etc., but not necessarily the same kind of experience of not feeling emotions. Another problem is that anticonvulsants are better at warding off depression than they are at preventing mania, so they are often used in combination with other drugs.

Antipsychotics
Antipsychotics are often used to complement anticonvulsants because they are more effective when it comes to preventing manic symptoms. The bad news about not feeling yourself? About 20-30% of the patients taking antipsychotics and atypical antipsychotics have problems with blunted emotion. It’s suspected that the way these medicines work to reduce psychosis is to manipulate the way emotion is processed overall.

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It’s incredibly important to consider side effects like your brain feeling dull. Patients often report that the mental effects of drugs impact them more than the physical side effects. Any side effects can cause people to choose to go off their meds. Medication is supposed to improve your quality of life, not make it worse. Right?

Because of this, it’s also incredibly important that doctors listen to their patients when they hear these types of complaints. When patients with bipolar disorder go off their medications (and a significant portion do), it greatly increases the chances of having symptoms return. But! Blunted emotions are symptoms of bipolar disorder anyway. The focus for both the patient and the physician should be finding a long-term and tolerable drug regimen. This can be a lengthy, arduous process on its own, but, in the end you’re more likely to find a good balance and have a better quality of life. Who doesn’t like that effect?

 

Why is this so important? Read Part II to find out.

 

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